Nutrition and Pregnancy

BUILDING A HEALTHY BABY

Your body can't build a healthy baby if you don't provide it with the materials it needs. Eating well, meaning getting adequate calories, protein, vitamins and minerals from eating healthy whole foods every day, is the most important part of prenatal care you receive - that you give yourself and your baby! No one else can do this for you. No prenatal vitamins or supplements can take the place of eating well.

While each woman is different, and her dietary needs will differ from those of another pregnant woman, in general pregnant women have special dietary needs above and beyond those of non-pregnant women. General guidelines follow, but if you fall into one or more of the following groups you will have nutritional needs beyond those of the average pregnant woman and will need a "corrective allowance" in the form of additional calories and protein1:

Underweight at the beginning of your pregnancy (5% or more under your ideal weight)

Undernourished at the beginning of your pregnancy (inadequate protein intake in the current diet)

Pregnant with more than one baby (twins etc.)2

Additional 500 calories and 30 grams of protein for each additional baby

Are currently breastfeeding2

Additional 500 calories and 30 grams of protein as long as breastfeeding continues

Have one or more of the following stress factors which affect nutritional needs: (an additional 200 calories and 20 grams of protein for each stress factor, up to a maximum of 400 calories and 40 grams of protein)

extreme vomiting

pregnancy spacing of less than one year

poor obstetrical history (previous stillbirths, prematurity)

serious life stresses (divorce, death in the family, loss of family income, etc.)

failure to gain at least 10 pounds by the 20th week of pregnancy

Other factors that may put you nutritionally at risk are: use of tobacco, alcohol, excessive caffeine, recreational drugs; anemia prior to pregnancy, vegan or macrobiotic diet.

The underweight and undernourished corrective allowances must be individualized for each individual situation based on the number of pounds underweight and/or the shortage of protein your current diet vs. your normal needs for protein in pregnancy. In general, for each gram of protein deficit in your diet you will need to add one gram of protein and 10 calories. If you are underweight you will need to add 500 calories and 20 grams of protein to your daily diet. These corrective allowances are started when needed and followed until the deficiency is corrected.

The following are some guidelines that are applicable to most pregnant women. You can use the charts on desirable weights and caloric/protein needs to help determine your non-pregnant needs. Be sure and consult with your midwife or physician if you are unsure of your personal nutritional requirements.

CALORIES:

Most women will need an extra 500 calories per day above their ideal non-pregnant needs. This extra 500 calories should be added at about the 20th week of pregnancy. (Note - this is 500 calories above and beyond any additional "corrective allowance" calories added at the beginning of pregnancy.) Caloric needs are based on your height, body frame, ideal non-pregnant weight, and current activity level. This usually comes to around 2500 - 3000 calories daily while pregnant. If you are under age 20 you will need additional calories since you are still growing your own body. Your non-pregnant calorie needs are approximately 2400 calories if you are 16 - 19, or 2600 calories if you are 13 - 15.

PROTEIN:

You wouldn't try to build a house on a weak foundation - it would create a shaky, weak house! Think of protein as the foundation for building your baby. Proteins are the primary building blocks of your baby's body. Your body can construct many of the proteins it needs, but 9 of them, known as essential amino acids, have to be eaten because your body cannot make them. Foods that contain all 9 essential amino acids are known as "complete proteins." Animal proteins (meat, fish, eggs, dairy) are complete proteins. Vegetable sources, other than soy, do not contain all 9 essential amino acids.

Your need for protein is increased, especially in the second half of pregnancy. You will need at approximately 80 – 100 grams of protein daily by the time you are about 20 weeks along, or 25 grams over your pre-pregnant requirements. Unless you are vegetarian this is really not difficult! If you are under age 20 you will need additional protein since you are still growing your own body. Your non-pregnant protein needs are approximately 75 grams if you are age 16 - 19, or 80 grams if you are 13 - 15.

Protein, along with sodium and water, is also crucial to adequate blood volume expansion during your pregnancy. It is normal for a pregnant woman's blood volume to increase an average of 40% during pregnancy. This extra blood is necessary to carry nutrients and oxygen to your baby and eliminate waste products. The extra blood also provides a cushion for any blood loss which occurs during childbirth.

IRON:

36 – 75 mg of iron daily. Helps prevent anemia. Some forms of iron are not very absorbable, and will cause constipation. Good natural sources of iron are: all meats, chlorophyll (2 Tbl daily), black-strap molasses (2 Tbl daily) and the herb Nettles. Nettles are high in chlorophyll, iron, potassium, phosphorus, sulfur, calcium, and vitamins A, C, D, and K. Avoid Ferrous sulfate. Ferrous citrate and ferrous gluconate are better sources. To help your body absorb iron, take any supplement with meals, and take with a vitamin C supplement or food. If you are taking an adequate amount of iron and are still anemic then absorption is probably the problem. Try taking Yellow Dock, an herb available in most health food and large-chain grocery and department stores. It is very high in B-vitamins and helps with the absorption of iron. If it causes diarrhea, reduce the dose or discontinue. Iron is toxic in too large doses.

FOLIC ACID: (Folacin, Folate):

800 mcg daily. Ideally, all women of childbearing age should be taking a folic acid supplement, since it has been found that a deficiency will cause neural tube defects, including spina bifida. Folic acid is mostly found in green leafy vegetables and legumes. Folic acid and vitamin B-12 work very closely together. B-12 is mostly found in meats, with the second highest amounts found in dairy products. The only non-animal source of much B-12 at all is fermented soy and cereal products such as Tofu and Tempeh. If you are a Vegan, you will probably need a B-12 supplement.

VITAMIN C:

Large doses of vitamin C are not recommended at the end of pregnancy since symptoms of vitamin C withdrawal have been seen in infants whose mothers were taking large doses. Doses of 500 - 1000 mg are safe, and some sources claim this amount will help strengthen the amnion and chorion (bag of water) and help prevent premature rupture of the membranes2. Taking vitamin C with iron will help the iron to be better absorbed.

CALCIUM:

You need between 1000 - 1500 mg of calcium daily. Builds bone and teeth; also important in blood clotting, proper functioning of nerves and muscles, activation of some enzymes, and prevention of calcium-deficient hypertension in at-risk populations, which include pregnant women. The best sources of calcium are dairy products. If you do not eat dairy products you will need to pay careful attention to calcium intake from other sources: broccoli, kale, collards, calcium-fortified foods, soft bones in salmon and sardines. Both Nettles and Red Raspberry leaves are good sources or calcium. There are two major sources of good calcium supplementation: calcium carbonate, and calcium citrate. Liquid forms of calcium carbonate are probably the most easily absorbed and utilized by the body, but may cause gas in some people. If this is a problem try switching to the citrate form. The best prenatal supplements do not contain calcium. This is because calcium will inhibit iron absorption. A good time to take calcium is at night since it promotes relaxation. Calcium should be taken with magnesium (350 - 400 mg daily) and vitamin D.

ZINC:

The "sunshine" vitamin. Researchers from the University of Pittsburgh, studied 200 black and 200 white women from the Pregnancy Exposures and Pre-eclampsia Prevention Study. They found that vitamin D levels were too low in 80 percent of African-American women and nearly half of white women. This occurred despite more than 90 percent of all women taking vitamin D supplements while pregnant. Poor maternal vitamin D status during pregnancy is a major risk factor for infant rickets.

Vitamin D helps increase mineral content of bones, assists in the absorption and utilization of calcium and phosphorus, assists kidneys to conserve minerals; maintain stable nervous system & normal heart action. Pregnant women should take between 200 IU and 400 IU daily. Can be toxic in large amounts.

OTHER:

These are by no means all the vitamins and minerals you need. Zinc and the B-complex vitamins are extremely important and are usually found in meats, green leafy vegetables, and whole grains. It is a good idea to begin taking a good, well balanced prenatal supplement as soon as you think you are pregnant, or ideally for several months before conception. Remember - supplements are meant to be just that: supplements. More is not necessarily better. Some vitamins and minerals can be toxic at high/mega doses including: A, D, E, K, Niacin, B6, PABA, and most minerals, especially iron.)

VEGANS: Vegans are considered to be at risk nutritionally during pregnancy. It is extremely difficult to get all the nutrients you need in the amounts needed for a healthy baby and a healthy pregnancy through a vegan diet. That does not mean it is impossible! If you are a vegan you will need to pay close attention to your diet every day, at every meal. Consider adding some animal-source foods such as eggs and milk to your diet during pregnancy and lactation.

A very basic guide to numbers of servings of various foods groups that you need each day:

What's Up With Salt?

Sodium is an extremely important component in your diet and yet many women still get misguided advice to not eat salt while pregnant. The American College of Obstetricians and Gynecologists stopped recommending salt-restriction to pregnant women in 1974, when it was finally acknowledged that this was not only not beneficial, but was potentially harmful!

Sodium works together with protein (albumin) to maintain a normal circulating blood volume. A pregnant woman needs additional sodium to help support her expanding blood volume. Additional sodium goes to the baby and to the expanding breast and uterine tissues also.

Commonly, friends and family will offer advice to cut back on salt if you are experiencing swelling. This is not a healthy solution to this problem (if it really is a problem) and can in fact cause problems. The correct response to swelling is to increase protein and fluid intake. You may even need additional salt if it has been hot or you have experienced increased perspiration. The general rule of thumb is: Salt your food to taste.